Cognitive Behavioural Therapy for Excessive Worry - Proven Strategies to Respond to Worry and Stress
When Worry Takes Over
Everyone worries from time to time. A touch of worry can even be helpful: it reminds us to double-check the front door is locked, motivates us to prepare for that presentation, or nudges us to plan ahead for a busy week.
But sometimes, worry doesn’t feel like a helpful ally. Instead, it can feel like a constant radio playing in the background, turning up the volume just when we want to rest. Many people describe lying awake at night, running through endless “what ifs,” only to wake up feeling drained. Others notice it during the day: struggling to focus, feeling tense in their body, or avoiding situations altogether because of imagined disasters.
The clients I work with often say: “It’s like my brain doesn’t know when to switch off — it just keeps checking and rechecking, as though worrying is the only way to feel safe.” If that resonates, you’re not alone.
How CBT Shifts Our Relationship With Worry
Cognitive Behavioural Therapy (CBT) is one of the most researched psychological treatments for anxiety and worry. Instead of aiming to “switch off” worry altogether — which is impossible — CBT helps us change the way we respond to worry, so it no longer dominates our thoughts or behaviour.
CBT teaches us how to:
Notice unhelpful thinking patterns and challenge them.
Separate useful, problem-solving worries from unproductive spirals.
Build tolerance for uncertainty (the fuel that often keeps worry going).
Develop practical coping strategies to reduce the impact of worry on daily life.
Think of it as retraining your mind: teaching it to distinguish between the alarm bell that signals genuine danger, and the one that rings simply because it might happen.
A Story: Anna and the Endless “What Ifs”
Anna, a teacher in her 30s, came to therapy exhausted by worry. Her mind played a constant loop of “what if” questions: “What if I lose my job? What if my parents fall ill? What if I say something stupid in the staff meeting?”
At night, her brain felt like it was preparing for every possible disaster. During the day, she felt distracted and disconnected. She wasn’t living in the present — she was living in her imagined future.
Through CBT, Anna learned a new way to respond. She started with a simple worry diary, writing down her concerns as they appeared. Later, she looked back and noticed a pattern: many of her fears never materialised. This gave her evidence that her mind’s “predictions” were often unreliable. Over time, she began to loosen the grip worry had on her.
Practical CBT Strategies for Managing Worry
Here are some of the most helpful strategies CBT offers. Each one can be adapted to fit your life.
1. The Worry Diary
What it is: Writing down worries as they arise, instead of letting them swirl endlessly.
Why it helps: Getting thoughts out of your head reduces their intensity. Reviewing them later helps you see patterns, check how realistic they are, and distinguish between solvable problems and hypothetical “what ifs.”
Try this:
Keep a small notebook or use your phone.
When a worry arises, jot it down and carry on with your day.
At the end of the week, highlight the ones that turned out to be false alarms.
2. Designated Worry Time
What it is: Setting aside a specific 20-minute slot each day to focus on worries.
Why it helps: Instead of letting worries hijack your whole day, you postpone them until your scheduled slot. This creates boundaries around worry and restores a sense of control.
Try this:
Pick a time (not right before bed).
If a worry pops up outside of that slot, gently tell yourself: “Not now — I’ll deal with this later.”
3. The Worry Decision Tree
What it is: A step-by-step tool to sort through worries.
Why it helps: It stops rumination by focusing on what’s within your control.
How it works:
Is this a real, current problem?
If yes → Can I take action now? → Plan the next step.
If no → Acknowledge it as hypothetical and let it go.
📖 Example: James constantly worried about losing his job. By using the decision tree, he realised there was no evidence of impending redundancy. Instead of spiralling, he chose one constructive step — updating his CV once a week. That single action gave him a sense of agency.
4. Mindfulness Meditation
What it is: The practice of noticing thoughts and feelings without judgment, allowing them to come and go.
Why it helps: Worries thrive on grabbing our attention and pulling us into their spiral. Mindfulness teaches us to step back and see worry as “just a thought,” not a fact.
Try this:
Spend 3 minutes focusing on your breath.
Each time a worry appears, label it “thinking” and gently return to your breath.
Over time, this increases your ability to tolerate uncertainty without getting hooked.
5. Problem-Solving
What it is: Turning worries about real issues into practical steps.
Why it helps: Worry can feel paralysing. Breaking problems into steps makes them more manageable and reduces the sense of helplessness.
Try this:
Define the problem clearly.
Brainstorm possible solutions (no judgment at this stage).
Choose the most practical option.
Take one small step today.
6. Behavioural Experiments
What it is: Testing out feared situations in small, safe steps.
Why it helps: Many worries stem from intolerance of uncertainty. By experimenting, you gather real evidence that feared outcomes are often less likely — or less catastrophic — than imagined.
📖 Example: Lina was convinced that if she didn’t check her emails every 15 minutes, something terrible would happen. In therapy, she experimented with waiting an hour. Nothing bad happened. With repetition, her confidence grew, and the fear lost its power.
✨ Key Take-Away Points
Worry is normal, but excessive worry can become overwhelming.
CBT doesn’t eliminate worry; it teaches you to respond differently.
Writing things down, scheduling “worry time,” and problem-solving are practical tools.
Mindfulness and behavioural experiments build tolerance for uncertainty.
Each small step matters — and adds up to greater peace of mind.
Moving Forward
Excessive worry can feel exhausting, but it doesn’t have to define your life. With practice, CBT strategies can help you:
Reduce the hold of “what if” thinking.
Build confidence in your ability to cope with challenges.
Spend more time in the present moment.
Focus your energy on what truly matters to you.
✨ Remember: CBT does not ask you to stop worrying altogether — it helps you change your relationship with worry, so it no longer controls you.
References & Further Reading
Borkovec, T. D., Wilkinson, L., Folensbee, R., & Lerman, C. (1983). Stimulus control applications to the treatment of worry. Behaviour Research and Therapy, 21(3), 247–251.
Craske, M. G., et al. (2014). Maximizing exposure therapy: An inhibitory learning approach. Behaviour Research and Therapy, 58, 10–23.
Hofmann, S. G., Asnaani, A., Vonk, I. J., Sawyer, A. T., & Fang, A. (2012). The efficacy of cognitive behavioural therapy: A review of meta-analyses. Cognitive Therapy and Research, 36(5), 427–440.
Hoge, E. A., et al. (2013). Randomized controlled trial of mindfulness meditation for generalized anxiety disorder. Journal of Clinical Psychiatry, 74(8), 786–792.
Smyth, J. M., et al. (2018). Effects of expressive writing on psychological and physical health: Meta-analysis. Psychological Bulletin, 144(8), 797–815.
Suggested further reading:
Leahy, R. L. (2019). The Worry Cure.
Wells, A. (1997). Cognitive Therapy of Anxiety Disorders.
Clark, D. A., & Beck, A. T. (2010). Cognitive Therapy of Anxiety Disorders: Science and Practice.
